Abstract/Project Summary The health care system is insufficiently capitalizing on the benefits of physical exercise in America's aging population. Significant barriers limit older adults from initiating and maintaining exercise programs. Additionally, few effective tools exist to help clinicians incorporate physical activity into their clinical care. Here, we seek to test the effectiveness of delivering an exercise and healthy lifestyle program ? Smart Aging ? to physicians and their older adult patients. Smart Aging represents a multi-level partnership between the University of Kansas Hospital and the Greater Kansas City YMCA network that is scalable, broadly implementable, and sustainable in the real world. The program begins at the patient-physician level with clinician-referral of interested older adults into the Smart Aging program via an electronic prescription embedded in the electronic health record. The Smart Aging program is then conducted in the community- based YMCA, extends into the participant's home (home exercise, mobile-health monitoring) and ultimately feeds physical activity data back to the clinician (?physical activity as a vital sign?). This proposal uses a rigorous randomized controlled trial design to test if the Smart Aging program induces meaningful and sustained health benefits. Participants will be randomized (1:1 ratio) to an immediate- start vs an education-only control group. We hypothesize that the Smart Aging program will benefit our primary study outcome of cardiorespiratory fitness at both 12 and 52 weeks (aim 1) and positively affect secondary metabolic measures of insulin resistance, body composition, and lipid status (aim 2). As our goal is to create a useful physician tool, we also explore important developmental outcomes (aim 3) relevant to the scalability and implementation of the program including physician adoption rates and referral patterns, barriers to use, and perceived usefulness through surveys and interviews. We will also assess the patient experience including drop-out rates and measures of satisfaction, quality-of-life, and self-efficacy. Our ultimate goal is to create a scalable and cost-effective program for clinicians and their patients to reduce the risk of chronic disease by inducing healthy lifestyle behavior changes through this multi-level intervention. The KU Alzheimer's Disease Center and YMCA of Greater Kansas City have experience in deploying various aspects of the Smart Aging program, from the referral process to m-Health monitoring, and now seek to test its comprehensive packaging for clinicians and their patients. If shown to be effective, the program will be deployable nationally to bring together health systems with community-based fitness resources.